Syphilis has been a blight on human populations for centuries now. It still is a significant cause of disease in some parts of the world and, more importantly, of newborn and infant (perinatal) mortality. Sub-saharan Africa is one of the most affected places, with 20% of all perinatal mortality being caused by this illness and the prevalence among pregnant women being 2.9%. Luckily the disease, caused by a bacteria called Treponema pallidum, is fairly straightforward to treat in its early forms. Here we discuss the established methods of treating syphilis.
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Different medicines to treat Syphilis
The treatment prescribed varies by whether we are facing early, non-disseminated, syphilis, or a later, more severe form. Early forms of syphilis in adults and adolescents are treated with either:
- A single dose of benzathine penicillin G given as an intramuscular injection. This is a long-acting form of penicillin which works to fight the bacterium over the span of a week.
- In the cases where benzathine penicillin G is not available (expense, buy-outs, low supply and etc.), procaine penicillin G may be used. The drawback of procaine penicillin G is its short duration of action, so a patient needs daily injections over 10-14 days.
About 8-12% of all patients are allergic to penicillin. The treatment for these patients includes one of the following:
- Doxycycline 100 mg orally twice daily for 14 days
- Ceftriaxone 1 g via intramuscular injections for 10-14 days
- A single dose of 2 g oral azithromycin
- Erythromycin 500 mg orally four times daily for 14 days (Used in pregnancy)
There are caveats to these treatments as well. Namely, doxycycline may not be used in pregnant women as it may cause bone abnormalities in newborns, ceftriaxone is expensive and out of reach for poorer populations, and some strains of Treponema pallidum are resistant to azithromycin. It is imperative to note that azithromycin and erythromycin only partially pass the placenta and thus do not treat the fetus, a newborn born to a mother treated with these must be treated separately after birth with either aqueous benzylpenicillin or procaine penicillin for 10-15 days.
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Treatment of later forms of syphilis is essentially the same as that of the earlier forms. The main important distinguishing factor is duration, which is often doubled or tripled compared to the earlier forms:
- Benzathine penicillin G is given weekly over three consecutive weeks.
- Procaine penicillin is administered daily for over 20 days.
- Doxycycline, erythromycin, and azithromycin are given orally over 30 days.
The World Health Organization (WHO) also strongly recommends that stock-outs of benzathine penicillin in antenatal care should be avoided at all costs as the risks of congenital and disseminated disease are substantial.
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The main challenges of syphilis treatment continue to be access to proper healthcare and the availability of medications in poorer regions such as south-east Asia and sub-Saharan Africa, requiring greater efforts from the international community.
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